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HomeMy WebLinkAboutCLE200600075 Legacy Document 2014-07-08Application for Zoning Clearance 4. OFFICE USE ONLY Zoning Clearance = $35 CLE # — _7,S (/ PLEASE REVIEW ALL 3 SHEETS Check # 146 I I Date: 3 - ..q' -D-t, Receipt # S _a'7 $ Staff: PARCEL INFORMATION Tax Map and Parcel: 0 U 10 0 O ©© O 12 O � PL) L V j(� n Existing Zoning, � p Parcel Owner: D yiA10ctrta A Pro o rt1 P �91'o /1Sd or ta�-iS ' L-1,� jt.4 I br�nVr tip Parcel Address: H 19 A I be m a v tt S a tj a y- .Q- C1ty .0 h"' 1'4r' r V .1 t e State zip !A 01 0 ) ----=------ -- -------- - - - - -- (include suite or tl --r) - - PRIMARY CONTACT - - - - - Who should we call /write concerning this project? D o d ! d to f k i. ee Address: °I Z3 q-0'1 a n s 81A dl CityCk o r I.. ti e3 V t 4 State l) a Zip 1 Z9 O J Office Phone: (ci 4 974{ -9 b4 Cell # 9 !31-214 1 Fax #-"9 7 y • 9 $ 10 E -mail D et v e M a «t c.. Conte --------------------------------------------------- ---- - - - - -- PROJECT INF0�2MaTTnN - - - ------------- - - - - -- - BusinessNam_, `Fe:. 1ihi�1 A_QL,j4- �.Q�it 1C_ �i�k� i't' °l111A- � P c, . Previous Business on this site: Proposed use: D o cl erf g Circle (if applicable): Fireworks / Christmas Tree SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1) *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the ownees permission to use the space indicated on this application. I also certify that the information provided is true and accurat to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed_ - - - - - [ - --- ------------------------------------- A4ROVAL INFORMATION - - - Approved as proposed Approved with conditions Backflow Device and/or [ ] Backflow device and/or current test data needed for this site. Contact ACSA 977 -4511, x11 Current Test Data Needed [y]-No-physical site inspection has been done for this clearance. Therefore, it is not a determin ifi�i?tAIY$s94l9 site plan. [ ] This site complies with the site plan as of this date. Building Official Date. LI n 10 (, Zoning Official Date �` ^ '0'C Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 . Voice: (434) 296 -5832 Fax: (434) 972 -4126 10/14/05 Page 2 of 4 Applicant to, complete the following: Y /N, Do you have one of the following? Tax Map and Parcel Number and or; Address of use (include unit or floor if appropriate; Y/N Do you have a Floor Plan (sketch or an architectural drawing) that includes the following, and if so please provide it with the application? The total square footage of the use and/or; The square footage of each room or area of use; Use of each room or area If using less than the entire structure, note the location within the structure. Tech to complete the fo Viol,,��'ons: Y /IN ) If so, st: ariance: Y/N Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Y Is parcel on private well and septic? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Y on public water and sewer? Y /® Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y N Wil ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Y in Is th r or sales of Fireworks? If so, obtain a copy of F/R permit. Permit # Y )/ N so, List: --2-m A- 19? z,—'2-q3 22--> j_ 's: /N 4f so, ist ��- (tR3 -036 r(-,iM-U4&CtJ- �Cra